Despite that worldwide, the age-standardized mortality rate for ischemic heart disease (IHD) decreased by 30.8% (95% CI -34.83% to -27.17%) over the past 30 years (1), cardiovascular diseases (CVD) are still leading cause of deaths in the world. In regard of sex-related differences, IHD mortality has been significantly decreased in women while fluctuated in men, and that difference was more pronounced in those born after 1945 in middle- and low-middle-SDI regions and after 1970 in low-SDI regions (1). Importantly, many of risk factors of CVD and IHD are preventable, particularly the ones related to diet.
The present commented study is an updated systematic analysis of the Global Burden of Disease Study of 54 countries in the WHO European Region from 1990 to 2019 on cardiovascular mortality attributable to dietary risk factors (2). An interesting notion from the study is that there are no sex-related differences in overall cardiovascular mortality, while the most common cause of death was IHD. More than third of deaths is attributable to an unbalanced diet, as follows: highest number of deaths attributable to a diet low in whole grain, followed by a diet low in legumes and, on a third place a diet high in sodium (2). Importantly, high-sodium diet and smoking mainly affected men, while both women and men had similar risks of low intake of whole grain and legumes (1) (REF).
Recent analysis of 27 prospective cohorts demonstrated that consumption of 118.5-148.1 g of whole grain per day was associated with lower risks of diabetes mellitus type 2, colorectal cancer, stroke and IHD. This association was inverse and non-linear for all observed diseases but stroke which followed a J-shaped curve (the greatest decline in the risk of stroke at consuming 100 g whole grain for a day) (3). Similarly, it has been shown that the whole grain-rich diet has decreased the IHD deaths in postmenopausal women (4). A prospective Danish Diet, Cancer and Health cohort study showed that a doubling the whole-grain consumption added 0.15 and 0.43 healthy years of life, for women and men, respectively, while duration of living with disease was shorter (5). The beneficial effect of whole grain consumption may be attributed to their content of many phytochemicals, including fiber and antioxidants (3) and magnesium. Namely, magnesium-rich diet decreases the risk of cardiovascular diseases and coronary heart disease in adults. Magnesium can be found, except in whole grain products, also in fruit, vegetables, legumes, nuts, coffee and tea (6), while lack of them was associated with premature cardiovascular mortality, as demonstrated in commented article (2).
It is well known that high salt dietary intake is strongly associated with cardiovascular and cerebrovascular mortality. For example, recently it was reported that adults with CVD had sodium intake of 3096 mg/day, more than double the recommended sodium intake of <1500mg/day (7).
Mediterranean diet (MedD) is an example of healthy balanced diet low in kitchen salt, red meat, refined sugar and ultra-processed food and high in unsaturated fats, vegetables, fruits, legumes and fish intake. In interventional study on 55 participants metabolic indices presented in healthy dietary metabolic signature (HDMS) were significantly improved after only 6 days of Mediterranean diet intervention. Several diet related metabolites were increased, such as acylcarnitine C11:0, acetylornithine, beta-carotene, caffeine, homostachydrine, hippurate, pipecolate, and 7-methylguanine. MedD demonstrated decrease in biomarkers of meat consumption and increase in biomarkers of fruits and vegetables consumption (8).
Altogether, balanced diet is the best approach in preventing premature cardiovascular mortality in observed European countries. The effect of diet may be monitored by metabolic biomarkers, such as HDMS, since cardiometabolic diseases and HDMS are inversely associated and HDMS contains biomarkers of healthy diet (8).
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